This is my contribution to series of emails between some friends and me. As is often the case, our original subject was lost fairly early in the thread and turned to the state of EMS and why some agencies that seemingly have nothing to do with EMS make decisions that have far reaching consequences for us and our patients.
I’ve removed some names and changed others to protect my friends’ anonymity since I didn’t ask for permission to quote them. Which is also why their own incredibly interesting comments are not in this post. Some of them read this blog and with luck will add their insights to my comments.
For those of you in EMS, I’d like to hear what you think.
For those of you not in EMS, I’d like to know if other professions are as disjointed and dare I say as dysfunctional as I think EMS to be.
I’ve edited this a bit from the original to improve clarity.
I’m semi cranky this morning, so I’ll comment.
The NAEMT started down the path of irrelevancy a long time ago. Now, it’s just a sad joke. I had high hopes for Jerry Johnston as president, but everything that he tried to do has essentially been undone because the same old cronies are back in place running the outfit.
They can pontificate as much as they want, but they are a non factor on the national EMS scene, such as it is. They spend most of their time and effort on self congratulatory bull shit. Well, that’s when they aren’t pimping their marginally useful classes. They certainly don’t speak for me or any of the EMTs or medics I know. In fact, out of the 300+ people I work with, I’d be surprised if I could find twelve people who are members, or fifty who even know what NAEMT is.
There is no real Massachusetts Association of EMTs, although there is a guy that says he’s the President of it. There used to be, but it’s been gone for at least twenty years. Other states do have associations, but I don’t know how effective any of them are in influencing laws or regulations.
From what I’ve seen, most field personnel in EMS don’t make enough money or are working incredibly hard to make enough money, to get involved in the political and advocacy sides of EMS. For which there is little money anyway. Which is why we get our heads handed to us by the IAFF, IAFC, NAEMSP, and other entities that have their own agenda for the future of EMS. They also have money and membership. Oh, and a unity of purpose.
There is no unified voice for EMTs in this country, because there is no unified model of delivery for EMS in this country. Fire, police, third service, volunteer, private, non profit, private for profit, and various combinations thereof deliver service, depending where you go.
In EMS, it seems that each time there is a disagreement within an organization, someone breaks away to form a new organization. Not to mention that each sub group in EMS has to have it’s own advocacy organization. As a result, everyone is constantly bickering with each other.
Many people still see EMS as a way point on their journey their real career. I’ve worked with people who have gone on to be doctors, nurses, lawyers, police officers, fire fighters, and any number of other careers. None of them thought that EMS, and I work for a service that offers serious money and benefits, was their final destination. In fact, many of them took pay cuts to move on. They did it because they didn’t see EMS as a viable long term career option.
It’s even worse in the private ambulance industry. Unless they plan and scheme to go into management, anyone with any level of ambition will move on in a few years. Earlier this week I rode in an ambulance with my mother as she went for a doctor’s appointment. One EMT was a carpenter by trade. He works full time in EMS and part time in carpentry. Want to guess where he makes more money? His partner, with a full four months in EMS, is waiting to get into nursing school. Once there, she’ll work enough to pay the bills while she studies for her real career.
I don’t think either one of them is unusual in that regard.
Even our own Warren is in EMS as an avocation, not a vocation.
Greg and Lenard, the reason that there are no upcoming stars in EMS is that the tired old ones (and I’m not talking about either one of you) are comfortable in their little fiefdoms and don’t want any new and upcoming “movers and shakers” to upset their particular apple carts.
Those of us that have been in EMS since the early days (even though I was in the second wave, not the first) wondered what EMS would be like when it grew up. Well, we’ve found out. It’s not the bright, bold, wave of the future that we hoped. No, it’s more of the couch potato, ne’er do well nephew, still watching WWE wrestling and trying to “find itself” as it enters it’s forties.
It could have been so much more.
I would love to be able to encourage my children to follow in my footsteps and up into the ambulance but I just can’t do it. After 25 years my base salary is in the mid thirties so like most of the rest of us work insane amounts of overtime just to keep food on the table and a roof over our heads. I got to see part of one of my oldest sons wrestling matches this year, missed all the rest. Can count on one hand the number of times my wife and I have been able to spend more than an hour alone. I love this job and feel like I was born for it, but I don’t want my children to struggle living paycheck to paycheck in an industry that treats us like a disposable tissue (there is always somebody behind you that will come in for less money). The dynamics of the job have changed so much in the past few years. I hope for just one patient during the entire day that really needs Emergency care. Just one and I consider it a good day, but more often than not it doesn’t happen. Med refills, ABNORMAL LAB VALUES OR FEVER at the nursing home with no attempt at treatment before running off to the hospital. And my personal favorite N/V/D X 2 HOURS or Days (we have them both happen) already been to er and got scripts (they didn’t really need) haven’t filled them aren’t any better and want to go another er. So many days I have wanted to paint a yellow checked strip down the side of the truck. Here in OK our OEMTA is only known for an annual medic update that is just a weekend long drunk fest. Our unions when we have one are broken up here and there and don’t have one voice. The firefighters have one union for almost all the firefighters in the country and they pay them a ton of money to hire pro’s to lobby for them and pay “business agents” to run the day to day operations of the union. I love patient care and the freedom of the street but don’t see a future in it anymore.
Your friend who originally wrote this is dead nuts about the NAEMT. They are a lobbying body that is as useless as they are overblown. Have you ever met Jerry Johnson? I have – he is an a$$hole…I’ll admit that I haven’t been around the business as long as you or the writer (in May of this year I will have been an EMS provider for 17 years) but I’ve been around long enough to see the changes, at least locally, both in Mass and NH. Some good, others not so much. But as a *profession* – we haven’t moved forward as much as we should have. Not even close.There are things that I personally would like to see happen. The first is the “raising of the bar” with respect to basically training EMT’s and Paramedics. It is slowly starting to happen, I think, but not without a huge struggle as well as inclination by those who have developed the standards (the DOT/NHTSA and the NREMT) are pushing a sort of “teach to the test” mentality. Another blogger (RM, I think) did a series of posts on that aspect of EMS that were on the mark in sketching out where we are, and I think it sort of dovetails with this posting as well. Because, like it or not, they go together.Having what amounts to true professionalism starts with how and what we learn. This is where the rubber meets the road, and as far as I’m concerned the inconsistencies out there are the root of the problem your writer outlines.Sorry, TOT – it’s near and dear to my heart, too.
Thank you both for your comments. It seems I’ve unleashed some pent up thoughts from both of you. I was hoping, but didn’t really expect, that I’d hear that I was over reacting. I’ve met Jerry, I think I’d use the term “politician” to describe him.
TOTWTYTR, I’m late to the comment party, and really don’t now anything about the EMT biz.I can say that the Internet Security biz is disfunctional to the point of being entirely broken. Functionality always trumps security, nobody really know how software works (let alone how to secure it), it’s easy to measure the benefit of hooking critical systems (like power grid controllers) to the ‘net but it’s impossible to accurately estimate the cost to secure it.”We’ll fix that later” is commonly heard, but nobody ever seems to get around to it.I’m much less worried about all the malware that corporations spend big bucks to fix; the Russians and Chinese taking over the power grid is nothing but made of fail.I guess that people don’t die when my industry screws up, though. Not sure if this helped or not.
My first thought was that nobody dies if your industry screws up, but on deeper reflection, it’s entirely possible for that to happen. The medical field is becoming highly, if not totally, computer dependent. My system does all of it’s patient reporting on computers, Walt’s will be, probably within a year. In five years all but the very smallest services will be. The hospitals are even more dependent. Charting, medications, physician orders, are all done by computer in most hospitals. Many procedures are done by or with heavy assistance from computer systems. Not to mention patient data management. If someone maliciously broke into a hospitals computer network, they could steal data, alter or destroy records, change medication orders and cause all sorts of damage. Hospital IT departments are notoriously paranoid when it comes to security. What I don’t know if they are paranoid and competent. “We’ll fix it later” is often heard in EMS, as we are great at mitigating emergencies, but generally suck at long term planning.
My system does all of it’s patient reporting on computers, Walt’s will be, probably within a year. In five years all but the very smallest services will be.My masters at CAS don’t quite understand that this needs to happen, and while it will happen as you said, there is what I perceive to be an incredible amount of resistance to it by the people who pay the bills. Imagine that! On the other hand, at RRA it took getting busted by the OIG to go electronic. And personally, I’m glad for it – the reporting really is easier, at least in my view.Borepatch is absolutely right about the “fix later” mentality in IT security. It’s frightening. For a while in my former life (actually, there was considerable overlap, but that’s for another day)I did some computer security consulting, and in many places I went to this attitude, for the most part, was pretty pervasive. About the only people who worried about it was the groups responsible for infrastructure, and they were almost always blatantly ignored. Because I looked at things from the network guys’ perspective much of the time I was either ignored or disregarded. Unfortunately, this happened once at the peril of the place I was working at. It was bad….
Well said. I recently wrote about this too and I’ve been feeling it for a while. It seems that it’s been a hot topic in the EMS blogosphere for the recent lil bit. Anyone who’s been in this business for more than a few years who’s in it for the right reasons wants this to be a profession that we can be proud of. It’s nowhere near that. I can’t believe that we’re destined to always be the redheadded stepchild of both public safety and the medical profession but I can’t see much on the horizon.I’ve got some suggestions but they always seem to fall on the collection of deaf ears. As I sit here on duty in the single-wide trailer that my service gives us to sleep in, it’s pretty hard to say where we go from here.Ckemtp http://proems.blogspot.com
I tossed you a link on my blog that I wrote on essentially the same topic
Ckemtp, thanks for the comments and the link. I’ll reciprocate.